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CDM1 > Exam 3: Cough > Flashcards

Exam 3: Cough Flashcards

1
Q

Cough: Mechanical stimulus

A

Mucus or nasal drippings down throat

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2
Q

Cough: Chemical stimulus

A

Breathing in chemicals in the air (teargas, cigarette smoke, etc.)

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3
Q

Cough: Physiology

A

Vagus and superior laryngeal nerves to cough center in brainstem, leads to complex series of involuntary muscular actions (cough reflex)

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4
Q

Cough: Causes

A

Common cold, viral infxn, pulmonary embolism, pneumonia, post nasal drip/upper airway cough syndrome (UACS), asthma, bronchitis, GERD, CHF, Meds (ACEI/BB)

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5
Q

Cough categories: Duration: Acute

A

≤3 weeks
Usually attributed to upper respiratory tract infection or cold
Only type of cough that should be self-treated OTC

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6
Q

Cough categories: Duration: Sub-acute

A

3-8 weeks

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7
Q

Cough categories: Duration: Chronic

A

≥8 weeks

Usually attributed to many things: meds, asthma, COPD, GERD

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8
Q

Cough categories: productivity: productive vs non-productive

A

Productive: produces phlegm/mucus/sputum

Non-productive: dry cough

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9
Q

Cough categories: Effectiveness: Effective vs Ineffective cough

A

Effective: successfully clears airway of phlegm/mucus/sputum
Ineffective: does not successfully clear airway

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10
Q

Upper Airway Cough Syndrome (UACS) formerly known as ___

A

Post-nasal drip syndrome

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11
Q

Upper Airway Cough Syndrome (UACS) def

A

Situation where a productive or nonproductive cough is associated with other upper respiratory symptoms such as nasal congestion, runny nose, tickle in throat, throat clearing
Nasal secretions drip and irritate throat and produce cough

Pt may not make association bt cough/nasal sx

**Often more at night when pt is laying down

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12
Q

Complications of untreated cough

A 
Exhaustion
Insomnia
Musculoskeletal pain
Hoarseness
Excessive perspiration
Urinary incontinence
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13
Q

Cough Treatment Goals

A

Reduce freq and severity of cough episodes

Prevent complications

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14
Q

Cough Self-care Exclusions

A

Cough with any of: chest pain, chills, cyanosis, fever, hemoptysis, lower extremity edema, night sweats, persistent headache, rash, SOB, throat tightness, unintended weight loss

Duration >7 days
Foreign object inhalation/aspiration
H/o cough associated with asthma/COPD
Drug associated cough
worsens/develops new symptoms during self-treatment
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15
Q

Cough Non-Pharm Treatment

A

Adequate hydration/fluids
Vaporizers and humidifiers
Non-medicated cough drops, lozenges, hard candies
Honey (1/2-1tsp prn, increases saliva prod and reduces irritation, caution for DM pts)

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16
Q

There is evidence honey is just as good as ____

A

Dextromethorphan

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17
Q

Cough Treatment Options: Step 1

A

Identify type of cough: non-productive/productive, UACS

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18
Q

Cough Treatment Options: Step 2

A

Select approrpaite agent based on type of cough and pt-specific factors

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19
Q

Cough Treatment Options: Step 3

A

Select appropriate dosage form

  • Infants/young children: liquid suspensions (shake before use)
  • Children >4yo: chewable/meltaway tabs
  • adults: regular or ER tabs
20
Q

Nonproductive Cough Treatment: 3 Options

A

OTC Oral antitussives, OTC topical antitussives, Rx Oral antitussives

21
Q

OTC Oral antitussives examples

A

Codeine

Dextromethorphan (Delsym, Robitussin)

22
Q

OTC oral antitussives: Codeine: MOA

A

Opioid agonist, centrally acting (increases threshold for cough reflex in cough center

23
Q

OTC oral antitussives: Dextromethorphan: MOA

A

NMDA antagonist, centrally acting (increases threshold for cough reflex in cough center)

24
Q

OTC oral antitussives: ADE/DDI

A

ADE: may cause CNS depression, N/V, drowsiness
DDI: MOAis

25
Q

OTC Topical antitussives examples

A

Camphor (Vicks VapoRub, Vicks VapoSteam)

Menthol (cough drops)

26
Q

OTC Topical Antitussives: MOA

A

Counter irritant

  • provide low grade stimulation of nerves in throat cell > prevents triggering of larger stimulation that causes cough
  • work like anesthetic > can make airways feel more open and breathe clearer
27
Q

OTC topical antitussives: ADE

A

Irritation/burning of eyes/nose/skin

Camphor: toxic if ingested, topical use only

28
Q

Rx oral antitussives examples

A

Hydrocodone/chlorpheniramine (Tussionex)

Benzonatate (Tessalon)

29
Q

Rx oral antitussives: Hydrocodone/chlorpheniramine: MOA

A

opioid agonist/antihistamine

30
Q

Rx oral antitussives: Benzonatate: MOA

A

Anesthetizes stretch receptors in airways to suppress cough reflex

31
Q

Rx oral antitussives: Hydrocodone/chlorpheniramine: ADE/DDI

A

Sedation, dizziness, dry mouth, constipation, N/V

CI: MAOis
Caution with other serotonergic agents and/or CNS depressants

32
Q

Rx oral antitussives: Benzonatate: ADE/DDI

A

Hypersensitivity rxn (avoid in pts with allergy to local anesthetics)

No DDI

Swallow capsule whole (don’t break or chew)

33
Q

Productive cough treatment options

A

Guaifenesin (Mucinex, Robitussin)

Drink Water

34
Q

Guaifenesin: MOA

A

Expectorant/protussive; incorporates water into mucus, increasing volume, and changing consistency (thinner)

35
Q

Guaifenesin: ADE/DDI

A

Rare but may include: dizziness, headache, diarrhea, N/V
Very high doses may causes kidney stones
No DDI

36
Q

UACS: Treatment

A

Decongestants + 1st gen antihistamines

*decongestants alone not effective, best when combo

37
Q

1st gen antihistamines examples

A

Bropheniramine (Dimetapp)
Chlorpheniramine (Chlor-Trimeton)
Diphenhydramine (Benadryl)
Doxylamine (Unisom)

38
Q

Brompheniramine Brand

39
Q

Chlorpheniramine Brand

A

Chlor-Trimeton

40
Q

Diphenhydramine Brand

41
Q

Doxylamine brand

42
Q

1st gen antihistamines MOA

A

Antagonist at central and peripheral H1 receptors (readily cross BBB) as well as antagonist at cholinergic receptors

Cough relief most likely due to anticholinergic effects that dry out nasal secretions and reduce post-nasal drip

43
Q

1st Gen Antihistamines ADE/DDI

A

Drowsiness (or possible excitability in children), CNS depression, respiratory depression, tachycardia, anticholinergic effects (blurry vision, urinary retention, dry mouth, dry eyes, CNS impairment: sedation, confusion, delirium, can mimic dementia)

*Beers for geriatrics, children may have paradoxical hyperactivity

DDI: avoid use with MAOi, additive CNS depression possible with sedative agents and other antihistamines

Will prevent reactivity of skin testing - d/c 4-10 days prior to test

44
Q

Spec pop considerations: Pregnant

A

Recommend non-pharm and refer to OB
Avoid codeine: birth defects possible in 1st trimester
Dextromethorphan is considered “probably safe”

45
Q

Spec pop consideration: Breastfeeding

A

Recommend non-pharm and refer to OB
Codeine is excreted in breast milk and may cause sedation in infants
Diphenhydramine can reduce milk supply and may cause sedation in infants
Unknown if dextromethorphan or guaifenesin are excreted in breast milk

46
Q

Spec pop considerations: Peds

A

Do not use cough and cold products in children <4 yo
Avoid opioid products in pts <18yo
May experience paradoxical excitation with antihistamines

47
Q

Spec pop considerations: Geriatrics

A

If used, use lowest dose possible
More likely to experience dizziness and sedation
1st gen antihistamines → Beers Criteria

CDM1 (19 decks)

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